INHALATION PNEUMONIA. ' 
615 
had closed, but the cough continued, the patient remained 
emaciated and weak, the appetite indifferent, the breath had 
again become foetid, especially evident during his fits of cough¬ 
ing, during which he expectorated through the mouth or ex¬ 
pelled through the nose dirty gray very foetid discharges. As 
there was evidently still some serious pathological condition 
present, we re-opened the laryngeal and tracheal wounds for ex¬ 
amination, finding each completely healed and all adjacent parts 
apparently normal. 
We had barely completed our physical examination of the 
parts when in a fit of coughing he expelled through the laryn- ^ 
geal incision an excessively foetid dirty grayish tenacious mass 
which it could now be no longer doubted had emanated from low 
down within the bronchii and indicated local purulent broncho¬ 
pneumonia. 
We then began anew the irrigation of the bronchii, the vol¬ 
ume, composition and mode of administration of the fluid re¬ 
maining the same, and being repeated daily. 
On the 15th we began the internal administration of quin¬ 
ine sulphate, 3 i, uux vomica grs. xx, and arsenic grs. ii, twice 
daily. 
At the first expulsive effort during each irrigation, the pa¬ 
tient expelled with the water about 10 c. c. of a dirty gray very 
foetid tenacious discharge, and on July 17th, he expelled a piece 
of foetid necrotic tissue estimated to weigh 2 grammes. 
On July 18th, the volume of water was reduced to 3 litres, 
the sodium chloride correspondingly, leaving it at 6^., while 
the volume of hydrogen peroxide was left unchanged. 
On July 19th, five days after the beginning of the regular 
daily irrigations, the foetor of the expectorated mass had greatly 
diminished, while its color had changed to almost that of ordi¬ 
nary mucous. 
July 20th no foetor could be detected in expectorate, nor in 
expired air. 
July 26th, the hydrogen peroxide was doubled, which caused 
more coughing and resulted in increased discharge of bronchial * 
